Perioscopy Innovative technology as an alternative to conventional periodontal surgical approaches By: Lori Clahane & Sharn Samra
(Perioscopy Incorporated, 2007)
Goal: To promote awareness of innovative non-surgical periodontal technology in dental hygiene
Objectives: What can I expect to learn?
1) What is Perioscopy? 2) Background 3) How does Perioscopy work? 4) Training for Perioscopy 5) Will Perioscopy hurt the client? 6) Who qualifies for Perioscopy? 7) How long does a procedure using Perioscopy take? 8) Does insurance cover Perioscopy? 9) Who is using Perioscopy? 10) Advantages and disadvantages 11) Before and after results 12) Videos 13) Related published articles
What is Perioscopy?
(Perioscopy Incorporated, 2007)
- Also known as periodontal endoscopy
- Uses advanced technology and great magnification to achieve visual access to root surfaces
- Decreases the need for periodontal surgical intervention
(Perioscopy Incoporated, 2007)
Periodontal endoscopy can also be used to help diagnose - Root fractures - Root anomalies - Subgingival caries (Splinder Periodontic Specialists, 2011)
"Following blind root planing, as much as 50% of the subgingival calculus beyond a depth of 4 mm remains"(Carroll, 2005)
Background:
- Clinical practice of periodontal endoscopy began in October 2001.
- The first dental Perioscope was named the DentalView DV2 Perioscopy System.
- Dentalview has since changed company ownership and has been renamed Perioscopy Incorporated. Dr. J.Y. Kwan is a pioneer in this realm of periodontics. He is the President and CEO of Perioscopy Incorporated and operates in California. Another similar periodontal endoscope system is called PerioPeak.
(Carroll, 2006)
How does Perioscopy work?
- Periodontal endoscopy provides 24x to 48x magnification of the root surface using fiber optic technology
- A special "explorer" instrument is used
- Images are captured onto a fiber that is connected to the explorer
- A single-use sterile sheath covers this fiber. This is where water is flushed through it and into the sulcus to provide a clear view
- The image is transferred to a screen so that the dental professional can see the magnified root surface (approximately 3mm is viewed at one time)
(Periodontics today, 2007)
Two types of explorers are used: 1) Shielded (indicated for periodontal debridement) 2) Unshielded (Kwan, 2005)
Training for Perioscopy
(CDA, 2005)
(CDA, 2005)
Learning how to master a periodontal endoscope is a difficult task
A lot of practice is required in order to be comfortable and successful with this instrument
The two-handed technique is the method of recommendation:
1) The endoscope is held in the clinician's left hand (assuming he or she is right handed)
2) The debridement instrument is placed in the right hand
3) The dental mirror is also held in the clinician's left hand
For professional training in Perioscopy: Training seminars in the United States Contact: Dr. Kwan, CEO of Perioscopy Incorporated
(Perieau, 2008)
Will Perioscopy hurt the client?
(Perioscopy Incorporated, 2007)
1) There is very little, if any, discomfort during a Perioscopy appointment. 2) Results are less damaging to the root surface as the periodontal endoscope allows the dental professional to visualize calculus deposits instead of solely relying on tactile sensation. 3) Some clients can be treated without anesthesia, while other clients prefer to be numb.
(Perioscopy Incorporated, 2007)
Who qualifies for Perioscopy?
(Top news network, 2009)
- Clients who are treated for initial periodontal therapy
- Non-surgical periodontal therapy: areas that did not respond to the treatment
- Suspected pathology located subgingivally
- Clients where periodontal surgery is contraindicated due to medication
- Clients who refuse periodontal surgery
- Clients who present with chronically inflamed or increasing periodontal pocket depths
(Perioscopy Incorporated, 2007)
How long does a procedure using Perioscopy take?
(Dental mall, 2011)
Full mouth treatment averages between 90-120 minutes for moderate to advanced periodontitis
These times are based on a dental professional who is highly efficient with a Perioscope
Initially treatments may need to be split while the clinician is still mastering the skills
(Perieau, 2008)
(Splinder periodontics specialists, 2011)
Does insurance cover Perioscopy?
Generally billing for Perioscopy is not a covered benefit.
Therefore, the client would pay out of their own pocket.
Billing is usually under NON-SPECIFIC PERIODONTAL PROCEDURE
Perioscopy treatment is generally quite costly. However, it may be cheaper than periodontal surgery or tooth extractions for a client who does not have these procedures covered under their dental insurance. One quadrant fee for Perioscopy procedure can range anywhere from $350-$900 and this may increase with the use of antibiotics.
*Note: This information is cited from American sources
(PerioPeak, 2011)
Who is using Perioscopy?
(Graphic resources, 2009)
Many dental professionals throughout the United States have incorporated Perioscopy within their practices.
As of yet, this technology has not been as widespread in Canada, although select dental practices do have the equipment.
(Perioscopy Incorporated, 2007)
(Periodontics today, 2007)
Advantages
- Improves client care
- May eliminate need for specialist referral
- In many cases it reduces need for periodontal surgery
- Less painful for the client than traditional periodontal therapy
Disadvantages:
- Is not covered by dental insurance
- Can be costly
(Perioscopy Incorporated, 2007) Before and after results:
(CDA, 2005)
3 months after regenerative periodontal endoscopy – normal healthy tissue 3mm- bone fill well underway, no mobility, and no need for an extraction and implant. This tooth was treated in 2006 and is still healthy. This patient saved thousands of dollars in treatment costs by avoiding an extraction, bone graft, impant, and crown.
Before regenerative periodontal endoscopy - 12mm pocket - advanced bone loss – this patient was advised by his periodontist he needed to have this tooth extracted and an implant placed. He chose RPE as a less invasive, more affordable option
(Perio peak, 2011)
Periodontal Surgery versus Periodontal Endoscopy
(Centre for oral health sciences, 1994)
(Splinder periodontics specialists, 2011)
Videos
Quiz:
1. What is the magnification of the Perioscope?
a. 1-2x
b. 16-24x
c. 24-48x
d. 48-64x
2. How long does the average appointment take for a Perioscope trained dental professional?
3. Approximately how many millimeters of surface space does the Perioscope allow the user to view?
4. Aside from non-surgical periodontal therapy used, what else can a Perioscope be used to diagnose?
5. What is another name for a Perioscope?
6. What year was the first Perioscope used clinically?
7. What is the preferred Perioscope technique called?
Innovative technology as an alternative to conventional periodontal surgical approaches
By: Lori Clahane & Sharn Samra
Goal: To promote awareness of innovative non-surgical periodontal technology in dental hygiene
Objectives: What can I expect to learn?
1) What is Perioscopy?
2) Background
3) How does Perioscopy work?
4) Training for Perioscopy
5) Will Perioscopy hurt the client?
6) Who qualifies for Perioscopy?
7) How long does a procedure using Perioscopy take?
8) Does insurance cover Perioscopy?
9) Who is using Perioscopy?
10) Advantages and disadvantages
11) Before and after results
12) Videos
13) Related published articles
What is Perioscopy?
- Also known as periodontal endoscopy
- Uses advanced technology and great magnification to achieve visual access to root surfaces
- Decreases the need for periodontal surgical intervention
Periodontal endoscopy can also be used to help diagnose
- Root fractures
- Root anomalies
- Subgingival caries
(Splinder Periodontic Specialists, 2011)
"Following blind root planing, as much as 50% of the subgingival calculus beyond a depth of 4 mm remains"(Carroll, 2005)
Background:
- Clinical practice of periodontal endoscopy began in October 2001.
- The first dental Perioscope was named the DentalView DV2 Perioscopy System.
- Dentalview has since changed company ownership and has been renamed Perioscopy Incorporated. Dr. J.Y. Kwan is a pioneer in this realm of periodontics. He is the President and CEO of Perioscopy Incorporated and operates in California. Another similar periodontal endoscope system is called PerioPeak.
(Carroll, 2006)
How does Perioscopy work?
- Periodontal endoscopy provides 24x to 48x magnification of the root surface using fiber optic technology
- A special "explorer" instrument is used
- Images are captured onto a fiber that is connected to the explorer
- A single-use sterile sheath covers this fiber. This is where water is
flushed through it and into the sulcus to provide a clear view
- The image is transferred to a screen so that the dental professional can see the magnified root surface (approximately 3mm is viewed at one time)
Two types of explorers are used:
1) Shielded (indicated for periodontal debridement)
2) Unshielded
(Kwan, 2005)
Training for Perioscopy
Learning how to master a periodontal endoscope is a difficult task
A lot of practice is required in order to be comfortable and successful
with this instrument
The two-handed technique is the method of recommendation:
1) The endoscope is held in the clinician's left hand (assuming he or she is right handed)
2) The debridement instrument is placed in the right hand
3) The dental mirror is also held in the clinician's left hand
For professional training in Perioscopy:
Training seminars in the United States
Contact:
Dr. Kwan, CEO of Perioscopy Incorporated
(Perieau, 2008)
Will Perioscopy hurt the client?
1) There is very little, if any, discomfort during a Perioscopy appointment.
2) Results are less damaging to the root surface as the periodontal endoscope allows the dental professional to visualize calculus deposits instead of solely relying on tactile sensation.
3) Some clients can be treated without anesthesia, while other clients prefer to be numb.
(Perioscopy Incorporated, 2007)
Who qualifies for Perioscopy?
- Clients who are treated for initial periodontal therapy
- Non-surgical periodontal therapy: areas that did not respond to the treatment
- Suspected pathology located subgingivally
- Clients where periodontal surgery is contraindicated due to medication
- Clients who refuse periodontal surgery
- Clients who present with chronically inflamed or increasing periodontal pocket depths
(Perioscopy Incorporated, 2007)
How long does a procedure using Perioscopy take?
Full mouth treatment averages between 90-120 minutes for moderate to advanced periodontitis
These times are based on a dental professional who is highly efficient with a Perioscope
Initially treatments may need to be split while the clinician is still mastering the skills
(Perieau, 2008)
Does insurance cover Perioscopy?
Generally billing for Perioscopy is not a covered benefit.
Therefore, the client would pay out of their own pocket.
Billing is usually under NON-SPECIFIC PERIODONTAL PROCEDURE
Perioscopy treatment is generally quite costly. However, it may
be cheaper than periodontal surgery or tooth extractions for
a client who does not have these procedures covered under
their dental insurance. One quadrant fee for Perioscopy
procedure can range anywhere from $350-$900 and this
may increase with the use of antibiotics.
*Note: This information is cited from American sources
(PerioPeak, 2011)
Who is using Perioscopy?
(Graphic resources, 2009)
Many dental professionals throughout the United States
have incorporated Perioscopy within their practices.
As of yet, this technology has not been as widespread in Canada, although select dental practices do have the equipment.
(Perioscopy Incorporated, 2007)
Advantages
- Improves client care- May eliminate need for specialist referral
- In many cases it reduces need for periodontal surgery
- Less painful for the client than traditional periodontal therapy
Disadvantages:
- Is not covered by dental insurance- Can be costly
(Perioscopy Incorporated, 2007)
Before and after results:
(Perio peak, 2011)
Periodontal Surgery versus Periodontal Endoscopy
Videos
Quiz:
1. What is the magnification of the Perioscope?
a. 1-2x
b. 16-24x
c. 24-48x
d. 48-64x
2. How long does the average appointment take for a Perioscope trained dental professional?
3. Approximately how many millimeters of surface space does the Perioscope allow the user to view?
4. Aside from non-surgical periodontal therapy used, what else can a Perioscope be used to diagnose?
5. What is another name for a Perioscope?
6. What year was the first Perioscope used clinically?
7. What is the preferred Perioscope technique called?
Related published articles:
http://www.perioscopyinc.com/HygieneTownArticle.pdf
http://www.perioscopyinc.com/documents/jop.2009.090160.pdf
http://www.perioscopyinc.com/documents/stambaugh.pdf
http://www.perioscopyinc.com/documents/TomWilsonArticleHisto.pdf
http://www.perioscopyinc.com/documents/aaplaserpositionpaperapril2011.pdf
Contact: Perioscopy Incorporated
6333 Telegraph Avenue
Oakland, California 94609
T) 510. 547.1300
F) 510.547.4976
Text References:
Carrol, J. (2006, November). The evolution of care: why perioscopy could change the
way you view your patients. Modern Hygienist, pp. 46- 48. Retrieved November 11, 2011
from http://www.periopeak.com/_media/pdf/Judy-Carroll-publications/MH1106_46-48_C-Perios.pdf
Kwan, J.Y. (2005, March). Enhanced periodontal debridement with the use of micro ultrasonic,
periodontal endoscopy. CDA Journal, 33 (3), pp. 243-244. Retrieved November 11, 2011
from http://www.cda.org/library/cda_member/pubs/journal/jour0305/kwan.pdf
Perieau. (2008). Perioscopy: getting started [Video]. Retrieved November 11, 2011
from http://www.youtube.com/watch?v=L-FDGaM7l90&feature=related
Perioscopy Incorporated. (2007). Perioscopy technology. Retrieved November 11, 2011
from http://www.perioscopyinc.com/perioscopy-technology.php
Perieau. (2008). Perioscopy: getting started [Video]. Retrieved November 11, 2011
from http://www.youtube.com/watch?v=L-FDGaM7l90&feature=related
PerioPeak. (2011). The cost of periodontal disease (gum disease) treatments. Retrieved
November 11, 2011 from http://periopeak.com/blog/category/cost-of-periodontal-treatments/
Perioscopy Incorporated. (2007). Perioscopy technology. Retrieved November 11, 2011
from http://www.perioscopyinc.com/perioscopy-technology.php
Spindler Periodontic Specialists. (2011). Dental endoscopy. Retrieved November 11,
2011 from http://spindlerperio.tripod.com/lvl30.htm
Image references:
Centre for Oral Health Sciences. (n.d). Basic periodontology [Online image]. Retrieved November 1, 2011, from
http://www.tandheelkunde.ugent.be/Website%20HUGO%20DE%20BRUYN/vip040826/basic.periodontology/flap.html
Dental mall. (2011). Dental adornment [Online image]. Retrieved October 29, 2011, from
http://en.dentalmall.cn/category.php?sort=goods_id&order=DESC&category=5&display=list&brand=0&price_min=0&price_max=0&filter_attr=&page=13
Graphic resources. (2009). Planet earth [Photograph]. Retrieved October 28, 2011, from
http://resources.bloguite.com/jpg/planet-earth-globe-giant-jpg/
Management Development Corporation. (2011). Research studies [Online image]. Retrieved October 8, 2011, from
http://www.mgtdev.com/research.html
Palmia. (n.d). Quiz [Online image]. Retrieved November 1, 2011, from
http://palmia.org/html/quiz.html
Perioscopy Incorporated. Publications [Online image]. Retrieved October 10, 2011, from http://www.perioscopyinc.com/publications.php
Perio peak. (2011). How regenerative periodontal endoscopy works: [Online image]. Retrieved October 8, 2011, from
http://periopeak.com/blog/category/case-studies/how-rpe-works/
Spindler Periodontic Specialists. (2011). Endoscopically assisted root debridement [Online image]. Retrieved October 7, 2011, from
http://spindlerperio.tripod.com/lvl30e.htm
Top news network. (2009). Free dental care to be given on January 29 [Online image]. Retrieved October 29, 2011, from
http://topnews.net.nz/content/211398-free-dental-care-be-given-january-29
ODEI. Cohort 9. Perioscopy. Lori Clahane & Sharn Samra.
Wikispaces (2011)